This proposed new project is an extension of ongoing research and development of an automated-medical-record-system for ambulatory care in Health Maintenance Organizations (HMO's). The objective of this research proposal is to do research on quality of care methodology. Specifically, our objective is to take advantage of an existing, but constantly evolving, automated-medical-record-system with its detailed, machine processable, clinical information in order to develop, to implement, and to compare various quality-of-care evaluation techniques. We aim to validate our system for accuracy, completeness, and adequacy, to quantify our clinical data base, to define the socio-demographic characteristics of the population, to determine the relationships among signs, symptoms, diagnosis, and therapy, to monitor and compare the clinical practice process of individual physicians, to explore the suitability of our coded data base for developing health indicators and health status of individuals and populations, to collect additional health outcome information and relate it to signs, symptoms, diagnosis, and therapy, to determine the usefulness of the various quality of care techniques and to integrate them with our patient care system in a cost effective manner, to improve our generalized coding scheme for clinical information, and to insure complete confidentially of individual patients.